03D1104696 CLIA NUMBER - ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER

Laboratory Demographics

CLIA Number: 03D1104696

Facility Name: ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER

Facility Address:
13575 W INDIAN SCHOOL RD SUITE 700
LITCHFIELD PARK, AZ
ZIP 85340
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Facility Phone Number: 623 535-9777

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811130016

Taxonomy: 2081P2900X - Physical Medicine & Rehabilitation
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.

CLIA Record

Field Name	Field Value
CLIA Number	03D1104696
LAB Type	Physician Office
Facility Name	ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER
Street	13575 W INDIAN SCHOOL RD SUITE 700
City	LITCHFIELD PARK
State	AZ
ZIP	85340
Phone	623 535-9777
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024